MAI KHADIJA INSTITUTE OF NURSING SCIENCES

SUBJECT: ADVANCED NURSING PRECTICE

ASSIGNMENT ON

“HEALTH CARE DELIVERY SYSTEM”

Submitted To

Mr. GIRISH SINGH

Assistant professor and HOD
Dept. of Community Health Nursing
Mai Khadija Institute of Nursing Sciences

Submitted By
Mr. Mohammed Rizwan
M.Sc. Nursing Previous
Batch – 2017-18

Submitted On
Health Care Delivery System in India
Mr.Mohammed Rizwan

M.sc nursing previous

Mai Khadija institute of

nursing
 INTRODUCTION

 Health is a state of complete Physical, Mental and Social well being and not merely an
absence of disease or infirmity which allows a person to live a socio-economically
productive life.
 Illness is a state in which a person’ s physical, emotional, intellectual, social or spiritual
functioning is diminished or impaired

 Health care is multitude of services rendered to individuals or communities by the agents

of health services or professional for the purpose of Promoting Restoring and
Maintaining health
 Embraces all the goods and services designed for “prevention, promotion and
rehabilitation interventions” includes Medical Care.

Health Care provider

 A person or organization that provides services and/or health care personnel to deliver
proper health care in a systematic way to any individual in need of health care services.
 Could be a government
 The health care industry,
 A health care equipment company,
 An institution such as a hospital or laboratory.

 Health care professionals may include physicians, dentists, and other support staff.

.
Health services

 Permanent countrywide system of estabilished institutions with the objective of:

 Coping with the various health needs and demands of population

 Thereby provide health care to individuals and community with preventive and curative
activities.
 Utilizing health care workers

System

 Includes concepts ( e.g health and diseases)

 Ideas(e.g equity)
 Objects(e.g hospitals, health centres)
 Persons (health care workers viz. Physician, nurses)
 Together these forms a system interacting with each other, supporting and controlling
each other.

Component of health care delivery system

1.Structure of health system

 Aspects of the design of health services that influences the way in which they are
delivered Includes….
 Number and type of personnel and staff
 Way of these personnel organized to work
 Nature and extend of facility and equipment
 Range of services offered
 System of management and amenities
 Financing
 Enumeration and determination of the eligible population for these services
 Governance and decision making
2. Process of health care delivery

Consists of two parts

 Behavior of professionals
 Recognition of the problem i.e diagnosis
 Diagnostic procedure
 Recommendation of treatment or management
 Appropriate follow up
 Participation of people Utilization of services
 Understanding the recommendations
 Satisfaction with the services
 Participation in decision making.

3. Outcomes of health care

 Aspects of health that results from interventions provided by the health system

4. Flow of patients in health care system

 Varies from country to country

 India harbors a multistage (three tier) system, where majority of health care is delivered
by community health care worker.
 Indian system is more cost effective if health workers are skilled and effectively
supervised
 Such system could one of the reason to reduced cost of health care in developing country
 Level of health care

 Primary Health care

Provided at the community level
 Secondary health care
Provided at PHC, CHC, DH etc.
 Tertiary health care
Provided at hospitals
Alma-Ata international conference

 In 1977, World Health Assembly decided to launch a movement called “Health for all by
2000”
 Fundamental principle of this concept was equity, an equal health status for all the
people in all countries
 This is to be ensured by equitable distribution of health resources
 In 1978, the note of “Health for all” was reaffirmed and marked as the major social goal
for every country.
 It was stated in the declaration that the best way to achieve HFA is by providing primary
health care especially to vast size of underserved rural and urban poor.
 Alma-Ata Declarations

 A main social target of governments, international organizations and the whole world
community in the coming decades should be the attainment by all peoples of the world
by the year 2000 of a level of health that will permit them to lead a socially and
economically productive life. - “HEALTH FOR ALL BY 2000”
 Primary health care is the key to attaining this target as part of development in the spirit
of social justice.
 Primary health care is essential health care based on practical, scientifically sound and
socially acceptable methods and technology, made universally accessible to individuals
and families in the community through their full participation and at a cost that the
community and country can afford.

Primary health care

 Primary Health Care as defined by the World Health Organization (WHO) in 1978 is…
 Essential health care; based on
 Practical,
 Scientifically sound, and
 Socially acceptable method and technology….
 Made universally accessible to individuals and families of the community through their
full participation.
 At a cost that community and country can afford to maintain every stage of their
development in the spirit of self determination.

DEFINITION

 Primary health care is essential health care made universally accessible to individuals
and acceptable to them through their full participation and at a cost the community
and country can afford.
What is there in Primary Health Care..???

 Primary Health Care includes:

– Primary Care (physicians, midwives & nurses);

– Health promotion, illness prevention;

– Health maintenance & home support;

– Community rehabilitation;

– Pre-hospital emergency medical services… and…

– Coordination and referral to other areas of health care.

 It is the first level of contact with the health system to promote health, prevent illness,
care for common illnesses, and manage ongoing health problems.
 Primary Health Care involves concerted effort to provide rural population of developing
countries with least bare minimum of health services.
 Some services are also provided community and hospitals
 Primary Health Care is different in each community depending upon: –
 Needs of the residents; –
 Availability of health care providers; –
 The communities geographic location; & – Proximity to other health care services in
the area.
 Elements of primary health care

 Education about prevailing health conditions and methods to prevent and control them
 Promotion of food supply and proper nutrition
 Adequate water supply and basic sanitation
 Maternal and child health care with family planning
 Immunization against major infectious diseases
 Prevention and control of locally endemic diseases
 Appropriate treatment of common diseases and injuries
 Provision of essential drugs.

\
 Health Care Delivery System in India

 India is a union of 28 states and 7 union territories.

States are largely independent in matters relating to the delivery of health care to the
people.
 Each state has developed its own system of health care delivery, independent of the
Central Government.
 The Central Government’s responsibility consists mainly of policy making , planning ,
guiding, assisting, evaluating and coordinating the work of the State Health Ministries

Health System in India

The health system in India has 3 main links:

At the central level

The official “organs” of health system at national level are

Ministry of Health and Family Welfare

Organization Structure
Function of ministry of health and family welfare

Union list

 International health relations and administration of port quarintine

 Administration of Central Institutes
 Promotion of research
 Regulation and development of medical, pharmaceutical, dental and nursing professions
 Establishment and maintenance of drug standards
 Census and collection and publication of other statistical data
 Coordination with states

Concurrent List:

 Prevention of Communicable disease

 Prevention of food adulteration
 Control of drug and poison
 Vital statistics
 Labour welfare
 Economic and social planning
 Poulation control and family planning

Directorate General of Health Services

Organizationchart
Functions of Directorate General of Health services

 General functions
 Surveys
 Planning
 Coordination
 Programming and appraisal of all health matters
 Specific function
 International health relations and quarantine of all major ports in country and
international airport.
 Control of drug standards
 Maintain medical store depots
 Administration of post graduate training programmes
 Administration of certain medical colleges in India
 Conducting medical research through Indian Council of Medical Research ( ICMR )
 Central Government Health Schemes.
 Implementation of national health programmes
 Preparation of health education material for creating health awareness through
Health.
 Collection, compilation, analysis, evaluation and dissemination of information.
 National Medical Library.

Central Council of health

Organization chart
Functions

 To consider and recommend broad outlines of policy related to matters concerning

health like environment hygiene, nutrition and health education.
 To make proposals for legislation relating to medical and public health matters.
 To make recommendations to the Central Government regarding distribution of grants
in-aid.

State Level
 At District level

There are 593 ( year 2001 census) districts in India. Within each district, there are 6 types of
administrative areas.

1.Sub –division

2.Tehsils ( Talukas )

3.Community Development Blocks

4. Municipalities and Corporations

5.Villages

6.Panchayats

Disrtict.level
 Health Services

Out patient services -Patients who don’t require hospitalization can receive health care in
a clinic. An out patient setting is designed to be convenient and easily accessible to the patient.

Clinics–Clinics involve a department in a hospital where patients not requiring

hospitalization, receive medical care.

Institutions– Hospitals – Hospital have been the major agency of health care system.

In broad sense the health services should be

a.Comprehensive

b.Accessible

c.Acceptable

d.Provide scope of community participation

E.Available at an affordable cost by country and commuity

Health care systems

Intended to delivery healthcare services and represented by five major sectors different from
each other by health technology

1. Public health sector

A.Primary health care

 Primary health centres

 Sub centres

B.Hospitals/Health centres

 Community health centres

 Rural hospitals
 District hospitals/health centres
 Specialist hospitals
  Teaching hospitals

C.Health insurance schemes

 Employees State Insurance

 Central Govt. Health Schemes

D.Other agencies

 Defense services
 Railways

2. Private sector

a.Private hospitals, polyclinic, nursing homes and dispensaries

b.General practitioners and clinics

3. Indigenous system of medicine

a.Ayurveda and Siddha

b.Unani and Tibbi

c.Homeopathy

d.Un registered practitioners

4. Voluntary health agencies

5. National health programmes

Primary health care in India

Introduction

 In 1977, GoI launched Rural Health Scheme based on the principle of “placing people’s
health in people’s hand”
 Subsequently in the international conference of AlmaAta(1978)the goal of “Health for
all” by 2000 through primary health care approach was set.
 Keeping in view WHO “Health for all” by 2000 GoI formulated National health policy
2002
 More recently GoI formulated NRHM and Indian Public Health Standards (IPHS) in this
regards
 In order to provide quality care in the public health agencies of health care delivery IPHS
are being prescribed.
 These standards provides basic promotive, preventive and curative primary health care
to the community and achieve and maintain an acceptable quality of care
 These standards would help monitor and improve functioning of the health care delivery
system

Rural Health care system in India

Rural Health care system in India

The health care infrastructure in rural areas has been developed as a three tier system and is
based on the above population norms:

Sub Center

The most peripheral and first contact point between the primary health care system and the
community.

 The Ministry of Health & Family Welfare is providing 100% Central assistance
 They are established on the basis of One SC for every 5,000 pop in general and
 One SC for every 3,000 pop in hilly, tribal and backward areas
 Each Sub-Centre is manned by one Male and one female Health Worker.
 One Lady Health Worker (LHV) is entrusted with the task of supervision of six Sub-
Centers.

Sub Centre are assigned tasks relating to interpersonal communication in order to bring about
behavioral change and provide services in relation to….

 Maternal and child health,

 Family welfare,
 Nutrition,
 Immunization,
 Diarrhea control
 Control of communicable diseases programmes.
  The sub centre are provided with basic drugs for minor ailments.

Primary Health Center

 PHC is the first contact point between village community and the Medical Officer.
 The PHCs were envisaged to provide an integrated curative and preventive health care to
the rural population with emphasis on preventive and promotive aspects of health care.
 The PHCs are established and maintained by the State Governments.
 At present, a PHC is manned by a Medical Officer supported by 14 paramedical and
other staff.
 It acts as a referral unit for 6 SubCentres.
 It has 4 - 6 beds for patients.
 The activities of PHC involve curative, preventive, primitive and Family Welfare
Services.
 National Health Plan (1983) proposed reorganization of PHCs on the basis of
 One PHC for every 30,000 pop in Rural areas
 One PHC for every.50,000 pop in Urban areas

Functions of PHCs

 Medical care
 Health programmes
 MCH care and family planning
 Health education and training
 Referral services
 Safe water supply and basic sanitation
 Prevention and control of locally endemic diseases
 Collection and reporting of vital events
 Basic laboratory services

Community Health Center (CHC)

 These were established by upgrading the primary health centers

  CHC are being established and maintained by the State Government.
 Centers each community health center should cover a population of 8000 to 1.2 lakh
 It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and
Pediatrician and supported by paramedical and other staff.
 It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory facilities.
 It serves as a referral centre for 4 PHC and also provides facilities for obstetric care and
specialist consultations

Functions of CHCs

 Care of Routine and Emergency Cases in Surgery

 Dressings, I&D, and surgery for Hernia, Hydrocele, Appendicitis etc.
 Emergencies like Intestinal Obstruction, Haemorrhage, etc.
 Other management including nasal packing, tracheostomy, foreign body removal etc.
 Fracture reduction and putting splints/plaster cast.
 Conducting daily OPD.
 Care of Routine and Emergency Cases in Medicine
 Daily OPD
 Handling all the emergency and routine cases.
 Maternal Health
 Minimum 4 ANC check ups including Registration & associated services
 1st visit: Within 12 weeks—preferably as soon as pregnancy
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term
 24 hr delivery services including normal and assisted delivery and cesarean section
 Managing labour using Partograph.
 Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for managing
Complications
 Newborn Care and Child Health
 Essential Newborn Care and Resuscitation Counseling on Infant and young child feeding
 Routine and emergency care of sick children
 Full Immunization of infants and children against VPDs
 Management of Malnutrition cases.
 Family Planning
 Counseling, provision of Contraceptives, NSV, Laparoscopic Sterilization Services and
their follow up.
 Safe Abortion Services
 All National Health Programmes delivered through CHCs
 School health services
 Others
 Blood storage facility

 Essential laboratory services

 Referral (transport) services

REFRENCE:

1. Samta soni, textbook of Advance Nursing Practice, published by jaypee brother medical
publication. Page no- 163-173.
2. Linkedin learning
3. www. Slide share